Growth charts for monitoring postnatal growth at NICU of extreme preterm-born infants

Aim: To provide growth charts for clinical monitoring of extra‐uterine growth from birth to full‐term age, in infants born before 26 weeks of gestation, hospitalized at neonatal intensive care unit (NICU), and compare it to the commonly used Swedish preterm birth‐size reference. Methods: This retrospective longitudinal cohort comprised all infants born before 26 + 0 weeks of gestation and surviving to full‐term age (n = 162), admitted to the NICU, Karolinska Hospital during the period January 1990 to December 2002. Body weight was recorded daily, head circumference (HC) weekly and length twice a month. Results: Birth weight (BW), length and HC showed a normal distribution without significant gender difference. The majority of the infants showed a pronounced postnatal growth restriction for all growth variables with increasing deviation from the reference with age. The mean initial weight loss was 16% with nadir at 6 days of age and a mean time to regain BW of 18 days. At discharge from NICU, 75% of those initially appropriate for gestational age infants were below –2 standard deviation scores for at least one of the body size variables. Conclusion: The poor extra‐uterine growth pattern points to the need of growth curves for extra‐uterine growth of extremely premature infants.     

Catch-up growth of supine length/height of very low birth weight, small for gestational age preterm infants to adulthood

OBJECTIVE: To analyze linear growth of very low birth weight (VLBW), small for gestational age (SGA; < 10th percentile) preterm infants from birth as to catch-up or no catch-up growth. STUDY DESIGN: VLBW SGA preterm infants (n = 46) with primarily symmetric intrauterine growth restriction from the Bonn Longitudinal Study were compared with 62 appropriate for gestational age (AGA) VLBW preterm and 73 term infants and with their parents. RESULTS: Forty-six percent of VLBW SGA (21 of 46) had complete height catch-up by adult age, and most became taller than target height (TH) (15 of 21; 71%). The others did not catch up; most of them remained shorter than TH (18 of 25; 72%) after initial catch-up followed by catch-down growth. Mean adult height z-score was lower than that for birth length. Mean body mass index was similar in the catch-up and no catch-up groups (21.8 and 21.3, respectively) and lower than in the controls (23.2). Approximately 1/2 of the head circumference (HC) catch-up children achieved height catch-up as well. CONCLUSIONS: Height catch-up extended beyond age 6 years, independent of HC growth. We could not predict height catch-down or successful catch-up.     

The relationship between intrauterine and postnatal growth on the subsequent psychomotor development of very low birthweight (VLBW) infants

ABSTRACT. The aim of this study was to demonstrate the relationship between intrauterine and postnatal growth and subsequent neurological and intellectual development of very low birth weight (VLBW) infants. The effect of intrauterine growth was assessed by comparing the developmental outcomes of the 131 appropriate weight for gestational age (AGA) infants with the 33 small for gestational age (SGA) infants. No significant differences were found between the two groups with respect to head circumference, neurological, intellectual or sensory handicap rates. The mean General Quotient (GQ) at the last clinic assessment for the AGA infants was 101.2 and 97.2 for the SGA infants. The effect of extra-uterine growth on subsequent development was assessed in the AGA and SGA infants separately, at the time of discharge and again at 12 months. The 31 AGA infants who failed to grow adequately in the nursery had more neonatal risk factors than the 100 AGA infants who continued to grow adequately after birth. This early postnatal growth failure was not predictive of developmental outcome. At 12 months of age, 26 infants (20%) who were initially appropriately grown at birth were failing to thrive. These infants had sustained more chronic diseases and caretaking disorders in the first year of life than their appropriately grown counterparts. They also had lower GQ and head circumference measurements (p<.05). The SGA infants who exhibited “catch up'’growth between birth and term had larger head circumference measurements at 1 year than those with persistent growth failure. Growth assessment at 12 months of age was not predictive of developmental outcome in SGA infants. We failed to show a relationship between intrauterine growth of VLBW infants and their subsequent development. AGA infants whose weights had dropped to the 3rd percentile by 12 months of age had a poorer outcome than their appropriately grown counterparts. Furthermore, early postnatal growth failure before term had no additional effects if catch up growth occurred thereafter. In the SGA group neither failure to reach the 3rd percentile by term or 12 months affected outcome.     

Early growth of term SFD infants in relation to caloric intake

Growth and development of 100 term SFD infants divided into 3 groups with body weight of 1·5 kg or less (I), 1·51–1·75 kg (II), 1·76–2·25 kg (III) and 100 AFD term infants was determined longitudinally. Group I and II infants remained smaller and had delayed milestones of development throughout the 1st year of life, with limited catch up only in body weight in the first 3 months. Their milk intake was low (132 ml/kg). Group III infants, who had comparatively better growth parameters at birth, showed effective catch up growth in all the parameters to reach the level of those of AFD infants within 3–10 months by increased consumption of milk (186 ml/kg). Their milestones of development were at par with that of AFD infants who consumed 160 ml of milk/kg/day in the first 2–4 months. The low consumption of milk by group I and II infants with severe intrauterine malnutrition is possibly related to the reduced appetite geared to a small body size.     

Accelerated postnatal head growth follows preterm birth

BACKGROUND: Poor growth after preterm birth, particularly poor head growth, is associated with impaired neurodevelopmental outcome. OBJECTIVE: To evaluate weight gain and head growth between birth and term in a contemporary cohort of preterm infants, taking into account breast milk intake and illness severity. METHODS: Subjects were inborn infants or=37 weeks postmenstrual age. Weight and head circumference (HC) were expressed as standard deviation score (SDS), growth between birth and discharge as SDS gain (SDSG), and illness severity and breast milk exposure as the number of days of level 1 (full) intensive care (%L1IC) and the number of days on which breast milk was received (%BM) as a percentage of days from birth to discharge. RESULTS: Infants showed poor postnatal weight gain but accelerated head growth. There was a highly significant fall in mean (SD) weight SDS between birth and discharge (-0.31 (0.96) and -1.32 (1.02) respectively, p<0.001) and a highly significant increase in HC SDS (-0.52 (0.95) and -0.03 (1.25) respectively, p = 0.003). %L1IC had a highly significant negative impact on weight SDSG (p = 0.006), and %BM had a significant positive impact on HC SDSG (p = 0.043). CONCLUSIONS: Accelerated postnatal head growth suggests catch up after antenatal restraint. This raises the possibility that poor neurocognitive outcomes after extremely preterm birth may in part be consequent on poor intrauterine brain growth. As postnatal head growth may be facilitated by breast milk, there is an urgent need to evaluate the optimal use of breast milk in preterm neonates. Illness severity is a significant determinant of poor postnatal weight gain.     

早产儿体重增长的动态评估及其意义

目的 研究早产儿宫内外生长迟缓发生率情况;显示该组人群婴儿时期生长模式.方法 回顾分析2002年1月至2009年4月,我院新生儿重症监护病房(Neonatal Intensive Care Unit,NICU)住院治疗,并坚持出院后随访的早产儿.入选标准:胎龄<37周;单胎;生后24 h内入院;住院时间≥14 d;出院后至少随访至校正年龄3个月.住院期间对早产儿宫内、外生长迟缓、生后2周及校正胎龄38～40周时仍住院患儿生长迟缓(≤生长曲线的第10百分位)情况进行描述,并对随访期早产儿生长迟缓情况及体重增长趋势进行描述.结果 符合纳入标准患儿共计239例(男135例,女104例),以体重评价,IUGR及出院时EUGR发生率分别为25.5%及40.6%,IUGR及出院时EUGR发生率均随体重减少而增加,未呈现随胎龄增加而降低的趋势.校正胎龄38～40周仍住院者生长迟缓发生率为61.8%.婴儿期校正年龄生长迟缓发生率38～40周20.5%,28 d 15%,61 d 8.8%,91 d17%,122 d 10.4%,152 d 10.1%,183 d 11.9%及274 d 7.4%,校正年龄3个月后生长迟缓发生率未再进一步降低.校正年龄6个月时女童生长迟缓发生率(19.3%)高于男童(3.8%)(x2=6.181,P=0.017).胎龄<32周、出生体重≤1500 g者中仅男童胎龄<32周者于校正年龄2个月及4个月时平均体重高于生长曲线第50百分位,余婴儿期平均体重低于生长曲线第50百分位.结论 早产/低出生体重儿是生长迟缓的高危人群,极低出生体重儿问题较为突出.生长迟缓问题随年龄增加有所减轻,远期预后有待进一步随访.     

早期足量胃肠道外营养对早产儿出院时体重的影响

目的探讨早期足量胃肠道外营养对早产儿出院时体重的影响。方法将我院收治的适于胎龄的存活低出生体重早产儿256例随机分为两组,各128例,治疗组应用早期足量胃肠道外营养,对照组应用传统新生儿胃肠道外营养。计算两组患儿各营养指标及出院时宫外生长发育迟缓(EUGR)的发生率,进行统计学分析。结果治疗组除生后第7天热卡与对照组相比 (P>0．05)无显著性差异外,其他各营养指标,如生后体重下降幅度、恢复至出生体重时间、每天体重增长克数、经胃肠达到摄入标准时间、应用胃肠道外营养天数、生后第3天热卡、平均住院天数等均优于对照组(P<0．01),具有非常显著性差异;治疗组出院时发生EUGR 60例,发生率为 46．9％,对照组出院时发生EUGR 87例,发生率为68．0％(x2=11．65,P<0．01),具有非常显著性差异。结论早期足量胃肠道外营养,可减少早产低出生体重儿或极低出生体重儿EUGR的发生率,为今后实现追赶性生长打下良好基础,且未见有严重副作用,值得临床推广应用。     

Growth of low-birth-weight infants

Growth in weight, length, and head circumference were compared among 3 different groups of infants. These measurements for each group were also compared to those presumed representative for the average fetus and infant of corresponding gestational age. A graph was prepared to show curves of fetal growth in the 3 parameters for the last trimester of pregnancy and through the 1st year of life after the equivalent age of "term" has been reached. The composite curves of the 3 groups were compared from the time of birth with no correction for gestational age. Since 1962 all low birthweight infants admitted to the Premature Center of the University of Oregon Medical School have been measured longitudinally for weight, length, and head circumference. 3 weight gestation groups were selected for study: Group A, very premature with weight appropriate for gestational age, gestation 27-29 weeks, birth weight .95-1.30 kg; Group B, moderately premature, with weight appropriate for gestational age, gestation 31-33 weeks, birth weight 1.40-2.00 kg; and Group C, full term, but severely underweight for gestational age, 38 weeks or more, birth weight less than 2.00 kg. Weight was obtained from an automatic Toledo balance scale, accurate to 10 gm. The babies were weighed prior to the morning feeding. Since measurements could not be made at precisely the same age for all infants after discharge from the hospital, derived measurements for appropriate intervals of time were extrapolated from the curves of growth of each infant. For estimation of fetal growth in weight, length, and head circumference, data were obtained from measurements reported in the literature for infants of known gestational age. After a 2-week lag, the curves for weightand length of Groups A and B paralleled those for standard fetuses and infants thoughout the 1st year of life. The curves were at a lower level with the curve of the most immature group (A) being reduced the most. Head circumference, after a 2-week lag, regained and followed the projectedcurve, suggesting a temporary acceleration in the growth of the head. This was in contrast to growth in length. Growth in Group C, after a lesser interruption following birth, also paralleled the mean curves of full-sized infants, but at a level substantially below them as well as those forthe Groups A and B. The curve for head growth in Group C gradually approached that of full-sized infants, but the significant disparity in head size from the normal-sized infant at birth was only partly reduced by the end of the 1st year. From the data it appears that little, if any, of the retardation in weight and length that may be suffered in the fetal or neonatal period is made up during the 1st year of life if the infant's age is corrected to term.     

Low thymic size in preterm infants in the neonatal intensive care unit,a possible marker of infection? A prospective study from birth to 1 year of age

Aim: To study the growth of the thymus in preterm infants. Methods: Ultrasonographic thymic size (Ti) was studied in 80 preterm infants (gestational age 24–36 weeks) from birth to discharge from the neonatal intensive care unit (NICU). Thirty‐three of these infants were followed to 1 year of age. Results: At birth, the median Ti was 5.2 compared with 11.8 in term infants. At discharge, the median Ti was 10.0 and not significantly different from Ti in term infants at birth (p = 0.22). The size of the thymus was significantly associated with postmenstrual age and weight (both p < 0.01). Infections during admission were negatively associated with the size of the thymus (p < 0.01). During the first 3 months after discharge, preterm infants had a significantly higher frequency of infections than did term infants (p = 0.002); hereafter, the preterm infants had significantly fewer infections than term infants (p = 0.002). The median Ti in preterm infants and term infants at 1 year of age was 21.1 and 17.3, respectively. This difference was not statistically significant (p = 0.41). Conclusions: Growth of thymus was not compromised by preterm birth. Ti is negatively associated with the frequency of infections in preterm neonates submitted to NICU.     

Growth in the first two years of uninfected children born to HIV-1 seropositive mothers

OBJECTIVE—To assess the growth curves of uninfected infants born to type 1 human immunodeficiency virus (HIV-1) seropositive mothers by means of standardised anthropometric indices.
METHODS—The z scores (National Center for Health Statistics-World Health Organisation data) of weight for age, length for age, and weight for length of 92 uninfected full term infants born to HIV positive mothers were compared with those of 65 bottle fed full term infants born to healthy mothers at 0, 1, 2, 3, 4, 6, 9, 12,18, and (in a subgroup) 24 months of age. Confounders were also recorded.
RESULTS—The study population had a lower length for age z score at birth (95% confidence intervals (CI): 0.02, −0.58) and higher weight for length z scores at 1 (95% CI: 0.21, 0.63), 2 (95% CI: 0.25,0.66), and 3 (95% CI: 0.0, 0.48) months compared with the reference group. After a temporary recovery, the length for age z score difference increased progressively from the 4th month onwards and was significant at 18 (95% CI: −0.31, −1.05) and 24 (95% CI: −0.02, −0.91) months. The difference between the length for age z scores at birth was associated with maternal covariates, but the between group difference at 18 months was apparent even after adjustment for covariates.
CONCLUSION—Uninfected infants born to HIV positive mothers have a rapid weight gain immediately after birth. A decrease in length progression during the second year might be a result of the social risk connected with the family environment and an unfavourable programming related to the maternal HIV status.

     

IUGR大鼠胰岛素样生长因子与小肠及体格发育关系的研究

目的：生后早期的生长主要受营养的调控,营养物质-胰岛素-胰岛素样生长因子(IGF)轴在胎儿宫内发育迟缓(IUGR)生长追赶及胃肠发育中起着重要的作用,而胃肠发育又与营养物质的吸收、生长追赶关系密切。目前国内有关IUGR出生时小肠发育状况报道甚少,且仅限于IUGR出生时胃肠形态结构的观察。该研究探讨生后早期不同蛋白质和热卡水平的营养干预如何调控IGF系统及影响IUGR大鼠的小肠发育和体格生长追赶,并追踪至成年期。方法：采用孕母饥饿法建立IUGR模型。64只IUGR新生鼠随机分为4组：IUGR正常饮食组(SC组),饮食中蛋白含量20%;IUGR高蛋白组(SH组),饮食中蛋白含量占30%;IUGR低蛋白组(SL组),饮食中蛋白含量为10%;IUGR高热卡组(SA组),饮食中热卡较其它组高20%。16只正常新生鼠为正常对照组(C组)予以正常饮食。幼鼠3周断乳后继续予原饮食模式1周,第4周起各组均予正常饮食喂养。分别于出生时及生后第4周、12周测定各组大鼠的血清IGF-1、胰岛素生长因子结合蛋白-3(IGFBP-3)浓度及体重、身长和小肠重量、长度。结果：IUGR大鼠虽然宫内营养不良,但SH组及SA组呈快速小肠发育和体格生长追赶伴IGFs水平明显升高,其中4周时SH组IGFs水平显著高于其余各组(P0.05)。SL组4周和8周的体重、身长、小肠长度和重量均低于其它4组(P0.05)。结论：4周时血清IGF-1是反映生长追赶的灵敏指标,与小肠和体格的生长追赶呈正相关,至成年期这种相关性消失。     

Differences in the length of initial hospital stay in very preterm infants

AIM: To investigate the effect of maternal, infant and birth hospital district related factors on the length of initial hospital stay in very preterm infants. In addition, rehospitalization rate within the first year from the initial discharge was studied. METHODS: A register study covering all very preterm infants (gestational age < 32 weeks or birthweight < 1501 g) born alive in Finland between years 2000 and 2003 (N = 2148). Factors affecting length of stay (LOS) were studied using generalized linear model (GLM). RESULTS: The proportion of very preterm infants born in a level III unit varied in the hospital districts from 53% to 94%. Median LOS was 53 days (interquartile range: 38-76). There were large regional differences in the LOS, the difference being up to 10.5 days among the hospital districts (p < 0.0001). Rehospitalization rate was 47.2% within the first year from the initial discharge, and the absence of rehospitalization was associated with a 4.1 days shorter initial LOS (p < 0.0001). CONCLUSION: Our study showed large regional variation in LOS of very preterm infants despite similar case mix. We speculate that the variation depends on differences in treatment practices and discharge criteria.     

新生儿重症监护病房中早产儿营养相关状况多中心调查974例报告

目的 了解我国早产儿在出生后早期的营养状况和影响其生长的高危因素.方法 采用回顾性调查的方法 ,收集2005年1月1日至2006年6月30日10所医院早产儿的临床资料,对影响早产儿生长的危险因素进行分析.组间行X2检验,计量资料行t检验.结果入选对象1000例,收集合格调查表974份.中位胎龄32.6周,中位出生体重1732.2 g.开始喂养时间为2(1,3)d.早产配方奶喂养占77.0%,母乳+早产配方奶喂养占13.6%.肠外营养应用氨基酸占87.3%,开始使用时间为2.5(2,3)d;平均使用时间为11(6,17)d;应用脂肪乳剂占56.9%,开始使用时间为3(2,5)d;平均使用时间为12(7,18)d.住院期间总热卡达120 kcal/(kg·d)者占74.1%,达标日龄平均为(16.3±9.4)d;口服热卡达100 kcal/(kg·d)者占84.1%,达标日龄平均为(17.0±9.4)d.早产儿平均生理性体重下降幅度为出生体重的7.54%±4.7%,恢复体重日龄(10.92±5.10)d,住院期间平均体重增长速度(13.4±6.0)g/(kg·d).对696例单胎早产儿在出院时以相应胎龄的百分位数进行评价,分别有60.0%、58.9%、29.5%的早产儿其体重、身高和头围低于第10百分位,较出生时有较大幅度的提高.结论出生体重小于第10百分位、开始喂养时间晚和体重增长速度慢是导致早产儿生后生长迟缓的危险因素.积极的营养支持策略对改善我国早产儿的营养状况及远期预后有重要意义.     

Growth pattern of low birth weight babies in the first year of life

Objective: The growth pattern of low birth weight (LBW) babies was studied prospectively in our hospital from September 1995 to august 1996.Method: Every baby <1.5 kg birth weight (B.Wt), every 2nd baby between 1.5 to 2 kg, every 6th baby between 2to 2.5 kg and 120 term appropriate for gestation (AGA) babies ( as controls) were included in the study. Severe birth asphyxia, multiple gestation, major malformations or severe birth trauma formed exclusion criteria. Weight, length and head circumference were measured in all babies at birth and at 2 monthly intervals till 1 year of age. All babies completing 1 year follow-up were included for final analysis. Growth distance curves were constructed separately for each parameter for the six categories based on birth weight (Groups I-VI) and on gestational age (Divisions A-F). Comparison was made between the LBW babies and the controls for growth pattern among the babies who completed 1 year follow up (total of 220 babies).Result: The growth pattern for weight and length showed good catch up growth in babies >1.25 kg B.Wt. and >30 weeks gestation, reaching almost the same level as controls by 1 year of age. Babies with B.Wt <1.25 kg and <30 weeks gestation showed late and poor catch up growth, with considerable lag persisting at 1 year of age. Head circumference increased rapidly in all babies, with maximal growth rate initially followed by a steady decline. All babies showed catch up growth, although those <1.25 kg and <30 weeks gestation still lagged behind even at 1 year.Conclusion: It was seen that the smallest and least mature babies had late and poor catch up growth. Recognition of the factors influencing catch up growth and adequate measures to improve growth (like attention to feeding practices) may improve the overall outcome of these babies.     

The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania

Objectives were to examine the growth patterns of preterm and growth‐restricted infants and to evaluate the associations of prematurity and intrauterine growth restriction (IUGR) with risk of stunting, wasting and underweight. Data from a cohort of HIV‐negative pregnant women–infant pairs were collected prospectively in Tanzania. Small for gestational age [SGA, birthweight (BW) <10th percentile] was used as proxy for IUGR. Anthropometry was measured monthly until 18 months. Length‐for‐age (LAZ), weight‐for‐length (WLZ), and weight‐for‐age (WAZ) z‐scores were calculated using the 2006 World Health Organization (WHO) Child Growth Standards. Stunting, wasting and underweight were defined as binary outcomes using a cut‐off of z‐scores. Multivariate Cox proportional hazard models were used to assess the associations between preterm and SGA to time to stunting, wasting and underweight. The study included 6664 singletons. Preterm and appropriate for gestational age (AGA) infants had slightly better nutritional status than term‐SGA infants and despite some catch‐up growth, preterm‐SGA infants had the poorest nutritional status. The gap in LAZ and WAZ z‐scores among the groups remained similar throughout the follow‐up. Compared with term‐AGA babies, relative risk (RR) of stunting among preterm‐AGA babies was 2.13 (95% confidence interval (CI) 1.93–2.36), RR among term‐SGA was 2.21 (95% CI 2.02–2.41) and the highest risk was among the babies who were both preterm and SGA (RR = 7.58, 95% CI 5.41–10.64). Similar magnitude of RR of underweight was observed among the three groups. Preterm and SGA infants should be closely monitored for growth failure. Intervention to reduce preterm and SGA birth may lower risk of undernutrition in resource‐limited settings.     

Health impact of catch‐up growth in low‐birth weight infants: systematic review,evidence appraisal,and meta‐analysis

This study aimed to systematically review and appraise evidence on the short‐term (e.g. morbidity, mortality) and long‐term (obesity and non‐communicable diseases, NCDs) health consequences of catch‐up growth (vs. no catch‐up growth) in individuals with a history of low birth weight (LBW).We searched MEDLINE, EMBASE, Global Health, CINAHL plus, Cochrane Library, ProQuest Dissertations and Thesis and reference lists. Study quality was assessed using the risk of bias assessment tool from the Agency for Health Care Research and Quality, and the evidence base was assessed using the GRADE tool. Eight studies in seven cohorts (two from high‐income countries, five from low‐middle‐income countries) met the inclusion criteria for short‐term (mean age: 13.4 months) and/or longer‐term (mean age: 11.1 years) health outcomes of catch‐up growth, which had occurred by 24 or 59 months. Of five studies on short‐term health outcomes, three found positive associations between weight catch‐up growth and body mass and/or glucose metabolism; one suggested reduced risk of hospitalisation and mortality with catch‐up growth. Three studies on longer‐term health outcomes found catch‐up growth were associated with higher body mass, BMI or cholesterol. GRADE assessment suggested that evidence quantity and quality were low. Catch‐up growth following LBW may have benefits for the individual with LBW in the short term, and may have adverse population health impacts in the long‐term, but the evidence is limited. Future cohort studies could address the question of the consequences of catch‐up growth following LBW more convincingly, with a view to informing future prevention of obesity and NCDs. © 2016 John Wiley & Sons Ltd     

Growth and neurodevelopmental outcome of VLBW infants at 1 year corrected age

Objectives

To evaluate growth and neurodevelopmental outcome of very low birth weight infants (VLBW) and compare with term normal birth weight infants (NBW) till 12 months corrected age.

Design

A prospective cohort study

Setting

Tertiary care neonatal unit in northern India

Subjects

37 VLBW infants and 35 NBW infants born between January 2007 and December 2007.

Interventions

Anthropometric measurements were recorded and Z-scores were computed serially at birth, discharge, 40 weeks post menstrual age (PMA), and at 1, 3, 6 and 12 months of corrected age. Developmental quotient (DQ) at 12 months corrected age was assessed.

Results

Z-scores for weight, length and head circumference (HC) at birth were ?1.21(±0.92), ?0.98(±1.32) and ?0.70(±1.14), respectively for VLBW infants and ?0.37(±0.72), ?0.11(±0.96) and 0.05(±0.73) respectively for NBW infants. VLBW infants had a significant drop in all Z-scores by discharge (P<0.001). There was a catch up to birth scores by 12 month age. VLBW infants had significantly lower Z-scores for weight, length and HC at one year corrected age as compared to NBW infants (P =0.01, 0.04 and 0.001, respectively). DQ at 12 months was significantly lower in VLBW infants (91.5+7.8) than NBW infants (97.5±5.3) (P <0.001). DQ of small for gestational age (SGA) and appropriate for gestational age (AGA) VLBW infants was comparable.

Conclusion

VLBW infants falter in their growth during NICU stay with a catch-up later during infancy. In comparison to NBW infants, they continue to lag in their physical growth and neurodevelopment at 1 year of corrected age.     

Factors associated with successful establishment of breastfeeding in very preterm infants

Aim: To describe feeding practices at hospital discharge in relation to characteristics of the very preterm infants (VPI) and their mothers. Methods: Design. Prospective hospital‐based registration of very preterm infants born with a gestational age ≤32 weeks in Denmark during 2004–2008. Subjects. Healthy mothers and VPI without diseases causing eating disabilities at discharge. Results: A total of 478 VPI were registered. At discharge, 60% were exclusively breastfed, 35% were exclusively bottlefed, and 5% were both breast‐ and bottle‐fed. Mothers of high social class (p = 0.000) and ‘not smoking’ (p = 0.003) were significantly more often breastfeeding their preterm infant(s) at discharge. Single births infants tended more often to be breastfed (p = 0.09). Infant age at discharge and duration of hospitalization did not influence breastfeeding at discharge. Increase in weight z‐score from birth to discharge was largest in the bottlefeeding‐group compared with the breastfeeding‐group (p = 0.000) probably as a result of feeding practice the last week(s) of hospitalization. Conclusion: Breastfeeding can successfully be established in very preterm infants. Mothers of low social classes, smokers, multiple birth and very preterm infants with low weight for age may need extra attention in breastfeeding establishing policies.     

Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life

Postnatal growth and development were studied in two groups of term infants with intrauterine growth retardation (IUGR) and one group of infants with normal birth weight up to 3 years of age (total sample, 205 infants). Infants with IUGR were classified as having low ponderal index (IUGR-LPI) or adequate ponderal index (IUGR-API). At birth, the two groups of infants with IUGR had similar birth weight, but length and head circumference measurements were significantly different. Overall, the IUGR-API infants remained lighter and shorter and had smaller head circumferences up to 30 months of age. The IUGR-LPI infants experienced catch-up growth in weight during the first months, because of greater fat deposition. At 24 months of age, the IUGR-API infants scored below the others on mental items. At 3 years of age the IUGR-API infants had the lowest values on seven of eight developmental measures and on the composite score; at these two time periods, the group with normal birth weight scored the highest, and the IUGR-LPI infants obtained intermediate values. It is concluded that infants with IUGR tend to follow postnatal growth and developmental patterns that are associated with their physical characteristics at birth.